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Successful Implementation of an Increased Viral Risk Donor Waiting List for Preconsented Kidney Transplant Candidates in Victoria, Australia
Increased viral risk donors (IVRDs) with increased risk behaviors for blood-borne virus infection and negative nucleic acid testing have a low absolute risk of “window period” infection. Utilization and allocation of IVRD organs differ between jurisdictions. METHODS. We examined the characteristics...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425849/ https://www.ncbi.nlm.nih.gov/pubmed/34514113 http://dx.doi.org/10.1097/TXD.0000000000001211 |
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author | Lee, Darren Gramnea, Indra Seng, Nina Bruns, Meaghan Hudson, Fiona D’Costa, Rohit McEvoy, Leanne Sasadeusz, Joe O’Leary, Michael J. Basu, Gopal Kausman, Joshua Y. Masterson, Rosemary Paizis, Kathy Kanellis, John Hughes, Peter D. Goodman, David J. Whitlam, John B. |
author_facet | Lee, Darren Gramnea, Indra Seng, Nina Bruns, Meaghan Hudson, Fiona D’Costa, Rohit McEvoy, Leanne Sasadeusz, Joe O’Leary, Michael J. Basu, Gopal Kausman, Joshua Y. Masterson, Rosemary Paizis, Kathy Kanellis, John Hughes, Peter D. Goodman, David J. Whitlam, John B. |
author_sort | Lee, Darren |
collection | PubMed |
description | Increased viral risk donors (IVRDs) with increased risk behaviors for blood-borne virus infection and negative nucleic acid testing have a low absolute risk of “window period” infection. Utilization and allocation of IVRD organs differ between jurisdictions. METHODS. We examined the characteristics and utilization of deceased donor IVRD kidneys and recipient outcomes within a 2-y period (July 31, 2018–July 31, 2020) postimplementation of a new opt-in allocation pathway for preconsented recipients in Victoria, Australia. RESULTS. Fifty-six kidneys from 31 IVRDs were utilized, comprising 13% of donors. Preconsent rate to accept IVRD kidneys increased to 41% of the waitlist in the 2 y postimplementation, and IVRDs having no kidneys utilized reduced to 0%. Compared with non-IVRD kidneys, kidney offer declines >10 per donor were less likely from IVRDs (3% vs 19%; P < 0.05). IVRDs were younger (median age 36 [IQR 30–44] vs 51 [35–60] y; P < 0.0001), with lower kidney donor profile index (25% [13–40%] vs 57% [29–75%]; P < 0.0001), and less hypertension (0% vs 22%; P < 0.01). Estimated glomerular filtration rate 3 mo post-transplant was superior (P < 0.01). Injecting drug use (61%) was the most common increased risk behavior. 29% of IVRDs were hepatitis C antibody positive but nucleic acid testing negative. No active infection was detected in any recipient post-transplant. CONCLUSIONS. The described opt-in system permits efficient allocation and utilization of kidneys from IVRDs, with superior quality and graft function. Education is crucial to facilitate informed consent and equity of access to this donor pool. |
format | Online Article Text |
id | pubmed-8425849 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-84258492021-09-10 Successful Implementation of an Increased Viral Risk Donor Waiting List for Preconsented Kidney Transplant Candidates in Victoria, Australia Lee, Darren Gramnea, Indra Seng, Nina Bruns, Meaghan Hudson, Fiona D’Costa, Rohit McEvoy, Leanne Sasadeusz, Joe O’Leary, Michael J. Basu, Gopal Kausman, Joshua Y. Masterson, Rosemary Paizis, Kathy Kanellis, John Hughes, Peter D. Goodman, David J. Whitlam, John B. Transplant Direct Kidney Transplantation Increased viral risk donors (IVRDs) with increased risk behaviors for blood-borne virus infection and negative nucleic acid testing have a low absolute risk of “window period” infection. Utilization and allocation of IVRD organs differ between jurisdictions. METHODS. We examined the characteristics and utilization of deceased donor IVRD kidneys and recipient outcomes within a 2-y period (July 31, 2018–July 31, 2020) postimplementation of a new opt-in allocation pathway for preconsented recipients in Victoria, Australia. RESULTS. Fifty-six kidneys from 31 IVRDs were utilized, comprising 13% of donors. Preconsent rate to accept IVRD kidneys increased to 41% of the waitlist in the 2 y postimplementation, and IVRDs having no kidneys utilized reduced to 0%. Compared with non-IVRD kidneys, kidney offer declines >10 per donor were less likely from IVRDs (3% vs 19%; P < 0.05). IVRDs were younger (median age 36 [IQR 30–44] vs 51 [35–60] y; P < 0.0001), with lower kidney donor profile index (25% [13–40%] vs 57% [29–75%]; P < 0.0001), and less hypertension (0% vs 22%; P < 0.01). Estimated glomerular filtration rate 3 mo post-transplant was superior (P < 0.01). Injecting drug use (61%) was the most common increased risk behavior. 29% of IVRDs were hepatitis C antibody positive but nucleic acid testing negative. No active infection was detected in any recipient post-transplant. CONCLUSIONS. The described opt-in system permits efficient allocation and utilization of kidneys from IVRDs, with superior quality and graft function. Education is crucial to facilitate informed consent and equity of access to this donor pool. Lippincott Williams & Wilkins 2021-09-07 /pmc/articles/PMC8425849/ /pubmed/34514113 http://dx.doi.org/10.1097/TXD.0000000000001211 Text en Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Kidney Transplantation Lee, Darren Gramnea, Indra Seng, Nina Bruns, Meaghan Hudson, Fiona D’Costa, Rohit McEvoy, Leanne Sasadeusz, Joe O’Leary, Michael J. Basu, Gopal Kausman, Joshua Y. Masterson, Rosemary Paizis, Kathy Kanellis, John Hughes, Peter D. Goodman, David J. Whitlam, John B. Successful Implementation of an Increased Viral Risk Donor Waiting List for Preconsented Kidney Transplant Candidates in Victoria, Australia |
title | Successful Implementation of an Increased Viral Risk Donor Waiting List for Preconsented Kidney Transplant Candidates in Victoria, Australia |
title_full | Successful Implementation of an Increased Viral Risk Donor Waiting List for Preconsented Kidney Transplant Candidates in Victoria, Australia |
title_fullStr | Successful Implementation of an Increased Viral Risk Donor Waiting List for Preconsented Kidney Transplant Candidates in Victoria, Australia |
title_full_unstemmed | Successful Implementation of an Increased Viral Risk Donor Waiting List for Preconsented Kidney Transplant Candidates in Victoria, Australia |
title_short | Successful Implementation of an Increased Viral Risk Donor Waiting List for Preconsented Kidney Transplant Candidates in Victoria, Australia |
title_sort | successful implementation of an increased viral risk donor waiting list for preconsented kidney transplant candidates in victoria, australia |
topic | Kidney Transplantation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425849/ https://www.ncbi.nlm.nih.gov/pubmed/34514113 http://dx.doi.org/10.1097/TXD.0000000000001211 |
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